ABSTRACT Rural South African schools face systemic underperformance due to infrastructural deficits, resource scarcity, and socio-economic adversity. This qualitative study investigates principals’ application of transformational leadership to turn around underperforming schools. A phenomenological design captured the lived experiences of five purposively selected principals from historically disadvantaged Quintile 1 secondary schools in Limpopo and North-West provinces. In-depth semi-structured interviews explored leadership challenges and strategies, with data analyzed through thematic analysis. The participants reported profound challenges: 1) Emotional exhaustion from relentless pressure; 2) Departmental abandonment with minimal oversight; 3) Hostility from staff/communities, including threats to safety; 4) Dysfunctional school cultures marked by financial mismanagement. Despite these challenges, they enacted transformational leadership through i) idealized influence (modeling transparency, adherence to rules, and personal accountability); ii) inspirational motivation (building morale via communal activities like shared meals); iii) intellectual stimulation (implementing peer-teaching programs among students); and iv) individualized consideration (mentoring struggling teachers through peer support networks). The participating principals in this small, context-specific sample demonstrated ways in which transformational leadership principles can support school improvement amidst extreme constraints. The findings underscore the critical need for contextual leadership development programs and robust departmental support systems to sustain turnaround initiatives. The study contributes practical strategies for educational equity in resource-scarce environments.

Effects of non-pharmacological interventions in patients with cancer-related cognitive impairment: A meta-analysis.

Effectiveness of cognitive rehabilitation in improving subjective and objective cognitive functions in cancer patients: A systematic review, pairwise, and network meta-analysis of randomized controlled trials.

Effects of computerized cognitive training on brain function in children with ADHD: A longitudinal neuroimaging study based on fALFF.

This study aims to systematically analyze the role of transformational leadership in orchestrating the achievement of Environmental, Social, and Governance (ESG) performance. Using a Systematic Literature Review (SLR) approach, this research examines a range of scholarly articles that explore the relationships among transformational leadership, organizational innovation, digital leadership, green leadership, and sustainability outcomes. The findings indicate that transformational leadership is a critical determinant in shaping a sustainability vision, mobilizing organizational commitment, and stimulating pro-environmental behaviors through idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration. The influence of transformational leadership on ESG performance operates primarily through mediating mechanisms such as organizational and green innovation, sustainability management systems (ESGM, CSR, EMA), as well as psychological mechanisms including green empowerment and environmental self-efficacy. Furthermore, digital leadership strengthens ESG orchestration by leveraging digital technologies that enhance accuracy, transparency, and accountability in sustainability reporting. Moderating factors such as external social capital, organizational inertia, and green training also shape the effectiveness of transformational leadership. Overall, this SLR highlights that transformational leadership functions as an “orchestrator” that aligns strategies, systems, innovation, technology, and employee behaviors to achieve long-term sustainability. The findings provide important implications for organizations in developing countries, including state-owned enterprises in Indonesia, in designing adaptive and competitive ESG leadership models and sustainability strategies.

Treatment of schizotypal disorder: A systematic review and GRADE evaluation of the certainty of evidence.

China is experiencing rapid population ageing, placing increasing pressure on health-care systems, social services and families. In 2019, the Shanghai Civil Affairs Bureau launched a citywide initiative to create dementia-friendly communities that integrate nonpharmacological interventions as an essential component. The bureau invited local agencies to apply for funding and design locally tailored interventions for people aged 55years or older with cognitive impairment. Approved projects received funding over a three-year period. The bureau conducted annual assessments of the projects, and projects rated as excellent were showcased during public awareness campaigns for dementia. Shanghai, one of China' s most populous and rapidly ageing cities, has an estimated 300 000 people with dementia. By 2023, all 216 subdistricts and townships in Shanghai had implemented a project. These projects provided cognitive training and education and incorporated one or more activities for participants, such as horticulture, games, music, exercise and aromatherapy. Among the surveyed participants in 44 projects conducted in 2023 and 2024, 85.1% (275/323) reported being satisfied or very satisfied, and 90.1% (291/323) believed the interventions met their needs. Shanghai's publicly funded model enabled citywide dementia-friendly projects, which were highly appreciated by participants. Future efforts should strengthen academic collaboration for evidence-based practice, and adopt standardized protocols with validated measures to ensure consistent assessment and readiness for scale-up. To reinforce progress, the bureau launched the 2025-2030 implementation plan to sustain continued funding and provide technical support.

Healthcare usage and cost-effectiveness of approach bias modification at 12-months for patients undergoing inpatient withdrawal for alcohol use disorder.

Background Hearing loss is one of the largest potentially modifiable risk factors for dementia and is linked with poor cognitive-motor dual-task performance (e.g., walking while performing a cognitive task). Hearing loss is more prevalent and severe in males, whereas dementia is more prevalent in females. Physical exercise and cognitive interventions appear promising in improving dual-tasking in older adults; however, it is currently unclear whether hearing ability affects training efficacy on dual-task outcomes in older adults with mild cognitive impairment (MCI), and whether sex influences this effect. Objective The primary aim of this study was to examine whether hearing ability affects dual-task performance at baseline and after training in individuals with MCI, and whether sex further influences these relationships, irrespective of intervention arm. Methods Secondary data was analysed from 75 participants with MCI ( M age = 73.66 ± 6.67) enrolled in the SYNERGIC trial. Hearing ability was assessed using self-report and behavioral measures. Participants completed a 20-week intervention: (1) Exercise (aerobic-resistance exercise + sham cognitive training; n = 31), (2) Multi-Domain Training (aerobic-resistance exercise + cognitive training; n = 32), or (3) Placebo Training (balance and toning exercises + sham cognitive training; n = 12). Primary outcomes included dual-task gait and cognitive performance. Results At baseline, poorer hearing predicted worse dual-task performance, particularly in males. Dual-task gait variability significantly improved following Multi-Domain Training in participants with a greater degree of self-reported hearing complaints. Sex-stratified analyses revealed that females with more hearing complaints improved more across all interventions, while in the Multi-Domain group, males with poorer objective hearing and females with better hearing showed the greatest gains. Additionally, in those with poorer hearing, lower cognitive scores (MoCA) predicted greater improvements after Multi-Domain Training, but a decline after Placebo Training. Conclusion Hearing ability, sex, and cognitive status appear to interact to influence the effects of exercise and cognitive training on dual-task performance in older adults with MCI. Multi-Domain Training appears particularly beneficial for those with hearing loss (who are male and/or have lower cognitive status), highlighting the need for personalized interventions to preserve function and slow decline in this at-risk population. Clinical trial registration https://www.clinicaltrials.gov/ct2/show/NCT02808676 , NCT02808676.

Morphological and microstructural brain changes induced by cognitive training among non-demented participants: a systematic review and meta-analysis.

Advances in paediatric oncology have improved survival, yet many children experience persistent neurocognitive and psychosocial sequelae also known as “Chemo-Brain”. These deficits, including slowed processing speed, reduced attention, and executive dysfunction, arise from both biological and contextual factors that jointly shape long-term quality of life. This scoping review synthesised recent evidence (2012–2024) on treatment-related cognitive and neuropsychological outcomes in paediatric cancer survivors, identifying mechanistic pathways, psychosocial correlates, and nursing interventions that promote cognitive resilience. Thirty eligible studies were reviewed across PubMed, PsycINFO, CINAHL, and Scopus. Data were extracted on cognitive domains, neurobiological mechanisms, emotional and educational correlates, and intervention effectiveness. Findings were mapped according to the PRISMA-ScR framework and integrated into a nursing-centred conceptual model. Between 25% and 75% of survivors exhibited measurable cognitive impairment, most commonly in processing speed and executive function. Mechanistic evidence implicated neuroinflammation, white-matter disconnection, and HPA-axis dysregulation. Psychosocial studies linked cognitive inefficiency with anxiety, depression, school difficulty, and social withdrawal, while intervention trials showed moderate benefits from cognitive training, mindfulness, and exercise programmes. The proposed Neuropsychological Nursing Support Framework outlines nurse-led screening, psychoeducation, and school liaison as central to integrated survivorship care. Paediatric oncology survivorship represents a dynamic continuum in which biological injury, psychosocial adaptation, and nursing coordination intersect. Embedding neurocognitive surveillance and family-centred rehabilitation into routine follow-up can transform survivorship from a period of vulnerability into one of developmental resilience.

To investigate the effect of home-visit cognitive function training among National Long-Term Care Insurance (LTCI) beneficiaries with dementia in Korea. We performed propensity score matching and difference-in-differences analysis over data from the National Health Insurance Service. The experimental group (n = 215) received home-visit cognitive function training for dementia for ≥6 months. Participants in the control group received general home-visit care. Physical function score increased significantly according to the time effect; the interaction term between time (at 12 months) and home-visit cognitive function training was significant. The interaction term was not significant for cognitive function. Home-visit cognitive function training had a partial effect among LTCI beneficiaries with dementia in Korea. Health care workers specializing in dementia should be educated as professionals who provide nonpharmacological intervention programs.

ABSTRACT This study examines the practice of Transformational Leadership (TL) in Ethiopian public research higher education institutions (HEIs) from the perspectives of academic and administrative staff. Grounded in TL theory, the study addresses an underexplored developing-country HEI context. A quantitative, descriptive survey design was employed, using standardised questionnaires administered to 726 staff members across three public research HEIs. TL was assessed across four dimensions: idealised influence, inspirational motivation, intellectual stimulation, and individualised consideration. Data were analysed using descriptive statistics and Bonferroni post-hoc tests. The results revealed significant institutional differences in idealised influence, with Hawassa Higher Educational Institution scoring lower than Jimma Higher Educational Institution and Addis Ababa Higher Educational Institution. No significant differences were found for inspirational motivation or intellectual stimulation, while individualised consideration approached significance, indicating relatively lower perceived support at HHEI. The study extends TL theory to a resource-constrained HEI context and offers practical insights for targeted leadership development interventions.

This study aims to analyze the transformational leadership of the West Bandung Regent for the 2022–2023 period in the context of community economic recovery after the pandemic. Transformational leadership with four main dimensions, namely ideal influence, inspirational motivation, intellectual stimulation, and individual consideration is used as an analytical framework to see the extent to which leadership style can encourage economic recovery in a participatory, innovative, and inclusive manner. The research method used is qualitative with a descriptive-analytical approach. Data collection techniques are carried out through documentation and in-depth interviews with informants from government, academics, business actors, media, and the community. Data analysis techniques are carried out thematically and inductively to trace the meaning of leadership actions and their impact on program implementation. The results of the study show that the Regent's leadership reflects a transformational character. The ideal influence dimension is seen in the courage to directly lead the economic assistance program. Inspirational motivation is reflected in the vision of regional development that drives community participation. Intellectual stimulation is realized through digital-based entrepreneurship training. Individual consideration is seen in dialogue activities with business actors at the local level. This leadership is able to improve bureaucratic performance and community involvement in economic programs. However, equal access to assistance and minimal business assistance are still obstacles. The conclusion of this study is that transformational leadership plays an important role in rebuilding the regional economy and needs to be further developed by strengthening the evaluation system and distributing information evenly throughout the region.

HIV neuroinvasion results in neuronal dysregulation and compromised neurocognition. Neuroplasticity measures, such as HIV cognitive rehabilitation, have shown potential for partially reversing cognitive deficits after HIV invasion. Previous functional NIRS (fNIRS) studies have demonstrated that customized attention brain training (ABT) has the potential to alter brain activity in adolescent HIV. Nonetheless, the effects of ABT on brain functional connectivity in adolescent HIV remain unclear. This study investigated behavioral and functional connectivity changes in adolescent HIV amongst participants (n = 26) receiving 12 weeks of ABT compared to treatment-as-usual (TAU) controls. Twenty-six adolescents living with HIV were recruited and randomly assigned to either the ABT group (n = 13) or the TAU group (n = 13). Participants completed NEPSY-II and fNIRS measures before and after the training. Functional connectivity (FC) measures were evaluated using seed-based correlation analysis, located in the central executive network (CEN) and across the hemispheres. No significant behavioral differences were noted on the NEPSY-II and BRIEF scores; however, functional connectivity measures indicated that the ABT group exhibited significantly increased FCs in the left hemisphere (p < 0.05) following brain training. Additionally, thresholding analysis indicated that the dorsolateral prefrontal cortex may serve as a potential marker for brain training in adolescent neuro-HIV.

The experience of pregnancy and having a baby is a time of significant change and transition. One in five perinatal women experience problems with their emotional wellbeing and mental health in this period; adjustment, anxiety and depressive illnesses being most common. Whilst investment in specialist perinatal mental health pathways continues, there is limited understanding of healthcare professionals' views and experiences of these pathways and of support available for women with mild or moderate mental health problems. This study explored healthcare professionals' views on the barriers and facilitators to identification and management of perinatal anxiety, and on how to optimise care pathways. In-depth semi-structured interviews were conducted with a purposive sample of healthcare professionals in universal perinatal services (including maternity, primary care, and health-visiting) and specialist (including talking therapies, maternal and perinatal) mental health services. Data were analysed using framework analysis. Interviews were conducted with 62 healthcare professionals from England and Scotland. 40% of the sample stated they had received no training in perinatal mental health, and 45% reported that they did not use standardised or validated questions or scales when enquiring about mental health. Themes related to barriers, facilitators, and service optimisation are presented for each stage of their care pathway: identification; disclosure; referral and assessment; care and treatment. Recommendations for optimising care included improving mental health education and training to strengthen perinatal healthcare and developing a sustainable perinatal mental health pathway, including for women with mild mental health problems. Healthcare professionals considered that the healthcare pathway for women with severe mental health problems was clear and well-developed, but that healthcare for women with mild and moderate anxiety and mental health problems was under-developed. Improvements in perinatal mental health education, in mandatory training for healthcare professionals, should be put in place in order to improve care. Increasing the number of staff and time available to address perinatal mental health is vital but requires additional resources and should be part of long-term strategies for funding.

Cognitive impairment is a common non-motor feature of Parkinson’s disease with no established treatments. Non-pharmacological interventions may promote neural plasticity and enhance cognition. However, high-quality trials are needed to confirm their efficacy and underlying mechanisms. We conducted a 24-week, single-center, randomized, single-blind clinical trial to investigate the efficacy of Immersive Virtual Reality (IVR) and adaptive Computerized Cognitive Training (CCT) for mild cognitive impairment in Parkinson’s disease (PD-MCI) in 51 individuals. Participants were randomized into an executive function-focused IVR intervention (n = 19) or a multidomain CCT intervention (n = 17). A standard of care (SoC; n = 15) group was also involved. Weekly 45-minute sessions were conducted. Baseline and post-intervention assessments included global cognition, functional, and neuropsychiatric measures, digital biomarker performance metrics, and structural and functional neuroimaging. IVR and CCT groups showed significant improvements in primary and secondary cognitive endpoints. Compared to the SoC group, the IVR group showed an improvement in the trajectory of the Parkinson’s Disease-Cognitive Rating Scale (PD-CRS), cognitive-functional dependency measures (PD-CFRS) and apathy at week 24. The CCT group showed a positive trend in the PD-CRS scores and a significant improvement in PD-CFRS. Digital biomarkers showed greater efficiency performance over time. Functional neuroimaging analyses revealed connectivity changes in large-scale cognitive networks in both intervention groups. Both interventions significantly improved cognition and functional outcomes in PD-MCI compared to SoC. Technology-based cognitive interventions offer a promising, adaptive, and personalized approach to managing PD-MCI. Registry: ClinicalTrials.gov, TRN: NCT05769972, Registration date: 03 March 2023.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-31833-1.

The rising prevalence of mental health conditions continues to place significant pressure on general practitioners (GPs) and general practice. Despite their critical role in managing mental health conditions, GPs and practice staff face substantial barriers in providing effective mental health care, such as time and financial constraints. A new mental health model of care (Link-me+EMPHN) aimed at engaging and building capacity in GPs and practice staff for the provision of mental health services is being designed and implemented in a Primary Health region in Victoria, Australia. This protocol describes formative research that aims to support the implementation of the Link-me+EMPHN Mental Health Model of Care in general practice, focusing on identifying current gaps in GP mental health training, assessing barriers and facilitators to implementation, exploring stakeholder perceptions and experiences, and determining needs and priorities for successful integration into routine practice. The formative research involves a multimethod approach comprising (1) a desktop audit of currently available mental health training and guidelines for GPs; (2) up to 20 semistructured interviews with GPs and practice nurses; (3) an online survey exploring current mental health care practice of GPs and practice nurses; (4) two co-design workshops with people with lived experience of mental health care help-seeking in general practice and four expert working group workshops with a multidisciplinary primary-care team; and (5) testing of the model of care in a simulated practice setting with GPs, patients, and Care Navigators. The desktop audit, online survey, and interviews will be mapped to the Theoretical Domains Framework to systematically identify gaps in GP knowledge and skills in providing mental health care. Thematic analysis of the interviews will provide context for the gaps found in current mental health care and training so that we can begin to address these. Findings from each of the co-design, expert working group, and simulation sessions will be thematically analyzed and will include key themes, insights, and any practical implications. The formative research received funding in May 2024, with the formative research components taking place from May 2024 to July 2025. As of June 24, 2025, a total of 5 people participated in co-design, 14 in semistructured interviews, 28 in simulation sessions, 30 completed the online survey, and 4 working groups have been held. The desktop audit yielded 270 results. The findings of the formative research are tentatively planned for publication in 2026. This formative research will generate a robust understanding of the factors influencing GP and practice engagement in mental health care and will provide practical solutions to improve implementation of the mental health model of care. The findings will contribute to creating a sustainable and scalable model that improves mental health outcomes for patients and supports GPs. DERR1-10.2196/79560.

BackgroundIdentifying strategies to mitigate age-associated cognitive decline is crucial. High-velocity power training enhances physical function in older adults and cognitive training has mixed cognitive benefits, however the combined effects of these interventions remain uncertain.ObjectiveThis 18-month cluster randomized controlled trial investigated whether dual-task functional power training (DT-FPT) enhances cognition in older adults and assessed if responses differ by apolipoprotein-E and brain-derived neurotrophic factor (BDNF) polymorphisms.Subjects and MethodsTwenty-two independent-living retirement communities (300 residents, ≥65y at increased falls risk) were randomized to 12-months of group-based DT-FPT (6-months supervised +6-months maintenance, 45–60 minutes, 2/week) performed simultaneously with cognitive and/or motor tasks, followed by 6-months follow-up, or usual care control (CON). Cognitive domains were assessed using CogState at baseline, 6, 12 and 18-months. Z-scores were created to form composites for psychomotor-attention, learning-working memory and global cognition. BDNF and APOE polymorphism data were obtained from blood samples.ResultsOverall, 223 (74%) participants completed the 18-month intervention; mean exercise adherence was 50% at 6-months and 40% at 12-months. Net benefits in choice reaction time and attention (0.17 SD, P = 0.016), psychomotor-attention (0.19 SD, P = 0.029), and a composite of psychomotor-attention, learning-working memory (0.11 SD, P = 0.046) were detected in DT-FPT vs CON after the 6-month supervised phase. At 12 and 18 months, benefits from DT-FPT relative to CON were extended to visual learning (0.29 SD, P = 0.013; 0.27 SD, P = 0.008) and learning-working memory (0.13 SD, P = 0.047; 0.18 SD, P = 0.013). CON exhibited a 0.19 SD net benefit for executive function (P = 0.003) after 18 months. BDNF Met carriers at 18 months showed improved working memory (0.35 SD, P = 0.042) and learning-working memory (0.37 SD, P = 0.011) in DT-FPT versus CON.ConclusionsIn older retirement living residents, DT-FPT may improve cognitive domains critical for functional independence, with genotype potentially influencing these outcomes.Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). This project was funded by the National Health and Medical Research Council (NHMRC) (APP1046267).

Background Mild cognitive impairment (MCI) is a critical period for the prevention of dementia, and multidomain interventions can effectively delay and improve patients’ cognitive decline. However, it remains a great challenge concerning the initiation and maintenance of interventions for MCI patients currently. Objective To explore influencing factors of the initiation and maintenance of multidomain interventions in patients with MCI. Methods This study was conducted with the recruitment of patients with MCI admitting to the Department of Neurology, Cognitive Center, and Cognitive Training Nursing Clinic of a Grade A Tertiary Hospital in Nanjing, as well as those identified through community screening, between September 2024 and February 2025 via purposive sampling. Data were collected via face-to-face semi-structured interviews. Meanwhile, data analysis for theme extraction in the study was performed through a deductive-inductive approach under the guidance of the multi-theory model (MTM). Results This study extracted two themes and eleven subthemes: Behavior initiation (perceived disease threat triggering service seeking and participation; disease cognitive biases and cognitive anosognosia hindering intervention initiation; perceived benefits of interventions; cognitive expectations of rehabilitation outcomes; barriers to accessing and utilizing intervention resources; economic cost–benefit tradeoffs). Behavior maintenance (positive experiences during interventions; self-regulation during interventions; diverse external support; high time preference during interventions; impact of frailty and comorbidities). Conclusion Multidomain interventions for patients with MCI are affected by complex and multiple factors. These factors should be considered in the clinical setting, with the formulation of targeted intervention strategies to improve patients’ participation in and adherence to multidomain interventions. Furthermore, it may contribute to the transformation of the interventions from effective to practical implementation and delay the progression of the disease.